Lignocaine 0. Exclusion criteria for this study were patients unwilling for the trial, those requiring rapid sequence induction and those with anticipated difficulty in venous access. On arrival of patient to the operation theatre, a 20 G intravenous cannula was inserted in a prominent vein on dorsum of non-dominant hand. All monitors like electrocardiogram, non-invasive blood pressure and pulse oximeter were attached.
A pneumatic tourniquet was placed on the same upper arm with pressure inflated to 70 mm Hg to produce venous occlusion. The study drugs were preservative free and kept at room temperature. Each of the study drug was prepared by independent Anaesthesiologists into 5 mL volume. The tourniquet was inflated for 1 min and study drug were given intravenously over 5 s and then tourniquet was released.
After 10 s severity of pain was evaluated using McCrirrick and Hunter Scale 2 2. Table 1 which was already explained to the patient. Then remaining propofol and neuromuscular blocking agent inj. Anaesthesia was maintained with O 2 , N 2 O and Isoflurane on intermittent positive pressure with Bain's circuit and Inj Vecuronium was used as muscle relaxant.
Relationships between categorical variables were tested using the Chi Square Test. Two sample t -test was used for comparison of normally distributed continuous variables between the two groups. Figure 1 Demographic data. Table 2 shows overall incidence and severity of pain after injection of propofol in the two groups. Thumbnail Table 2 Demographic data. The demographic data were compared among the two groups. There was no significant statistical difference among the 2 groups in relation to the weight and sex except the age parameter which was clinically insignificant Fig.
The study showed that there was no difference in the pain score which was statistically significant. No patient in this study had severe pain. No adverse effects like oedema, pain, wheal response at the site of injection were observed in the study. Figure 2 Severity of pain score. Propofol induced pain is considered to be one of the most important problems of current clinical practice. It was rated as the seventh most disturbing experience to the patient in anaesthesia practice by a group of experts.
Which clinical anesthesia outcomes are both common and important to avoid? The per- spective of a panel of expert anesthesiologists. Nature of the vascular pain is expressed by the patients as aching, burning and crushing. Ondansetron pretreatment to alleviate pain on propofol injection.
The perspective of a panel of expert anesthesiologists. Anesth Analg ; 88 5 : — Google Scholar. Anesth Analg ; 96 2 : Ups J Med Sci ; 4 : — Jeon Y. Reduction of pain on injection of propofol: Combination of nitroglycerin and lidocaine.
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Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. The incidence and intensity of recall of PIP on the first postoperative day was presented in Table 5.
Of those who could recall, Overall, most patients considered PIP as a relatively minor problem. Those who recalled mild PIP felt it was temporary, acceptable, and lighter than intravenous puncture pain. Only one patient in our study recalled severe PIP, which was caused accidentally by taking blood pressure during propofol injection on the ipsilateral upper arm.
Propofol has been widely used in clinical practice. However, pain after injection is one of the most common side effects of this intravenous anesthetic. This common but low-morbidity clinical anesthesia problem has been paid enough attention by researchers over the last decades.
However, is PIP really important to patients? Maybe such pain is considered important just by clinicians but not patients. Besides, as midazolam and propofol are commonly used in anesthesia induction, the amnesic effects of the two drugs may blunt recall of PIP after surgery [ 11 — 14 ]. In our study, the preference assessment tool of priority ranking was used to study patient preferences and determine their opinion on the problem of PIP.
Incisional pain was ranked as the most undesirable, followed in order by vomiting, gagging on the tracheal tube, nausea, sore throat, propofol injection pain, shivering, intravenous puncture pain, and anxiety.
Most patients view propofol injection pain as a relatively minor problem. Under routine general anesthesia in our hospital, the incidence of recall of PIP was low 8. So far, PIP has been adequately studied with plenty of labor forces and financial resources inputted. A great many effective non-pharmacological and pharmacological approaches have been recommended to prevent or alleviate PIP including venous occlusion by a tourniquet [ 15 ], alternative propofol formulations [ 16 , 17 ], changing physical properties of propofol [ 18 , 19 ] and pretreatment with lidocaine or opioids [ 20 — 23 ].
However, none of these can eliminate PIP completely. Besides, as a practical matter, many above methods are not routinely available and will delay busy operating room schedules. The most pragmatic option for preventing PIP should be the simple effective method that allows clinicians to use routinely available drugs and avoids delay to busy operating room schedules [ 10 ].
Thus, lidocaine and opioids, either as a pretreatment or mixed with propofol, are reasonable options as they are routinely administered during induction of anaesthesia and convenient to perform in busy clinical situation [ 10 ]. In our hospital, PIP is not adequately managed as lidocaine is not routinely used during induction of anesthesia.
Even in this case, though, the incidence of recall of PIP was low and most patients view PIP as a relatively minor, acceptable problem. Maybe we should no longer need to spend too much time, energy and financial resources on the problem of PIP.
Although there is interindividual variability in patient preferences, our study showed that avoiding incisional pain, nausea and vomiting still seems to be major concerns of patients.
This finding is consistent with previous studies [ 3 , 7 ]. Thus, maybe priority should be given to the management of postoperative pain, nausea and vomiting and more time and resources should be spent to minimize these distressing clinical problems. There are some limitations to our study. Firstly, potential selection bias may exist in our study as the sample of patients surveyed was from a single tertiary specialized cancer hospital scheduled for elective open thyroidectomy under general anesthesia.
We do not know whether similar results would be obtained in patients undergoing major surgeries or in patients with chronic pain conditions. Thus, the finding in our study should be generalized to other patient populations carefully and further investigations into PIP may be warranted. Secondly, our study population mainly included middle-aged and relatively well-educated patients. As cognitive biases may affect the results of survey based study [ 24 ], it is unknown if the results represent the general population.
Thirdly, we only investigated the ranking of PIP by the patients before surgery. However, it would have been useful to compare the rankings of PIP by the patients before and after surgery.
Fourthly, propofol was applied to induction of anesthesia in our study. We do not know whether there is a difference between using propofol for sedation and using it for induction with respect to patient recall. In our study, we found that most of patients undergoing elective open thyroidectomy viewed propofol injection pain as a relatively minor problem.
The incidence of recall of propofol injection pain was low and the majority of those who recalled regarded it as temporary and acceptable pain, which was lighter than intravenous puncture pain. Voluntary reporting system in anaesthesia: is there a link between undesirable and critical events? Qual Health Care. Which clinical anesthesia outcomes are both common and important to avoid? The perspective of a panel of expert anesthesiologists.
Anesth Analg. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. The objective of this review was to determine how effective lidocaine was in reducing the high pain levels caused by the injection of propofol. We searched the databases until October We included 85 studies, 82 of which 10, participants were eligible for quantitative analysis.
The study participants were randomly selected to receive either intravenous lidocaine injection or normal saline placebo at the same time as the propofol injection.
We reran the search in November Three out of the 85 studies were funded by either a pharmaceutical manufacturer with a commercial interest in the results of the studies or the company which supplied the propofol.
Eight studies were supported by government hospital or university funds and one study was funded by a charitable grant. We found that the injection of lidocaine into a vein, either mixing lidocaine with propofol or injecting lidocaine before propofol, could effectively reduce the incidence and the high levels of pain associated with the injection of propofol.
Adverse effects such as inflammation redness, swelling of the vein at the injection site were rare and in two studies were not more frequent with the use of lidocaine. No study reported on patient satisfaction. Based on these results we would expect that out of patients receiving intravenous propofol, about who did not also receive intravenous lidocaine, would experience moderate to severe pain, compared to only 89 patients who also received intravenous lidocaine.
The overall quality of evidence was high with a very large beneficial effect obtained by the administration of lidocaine to reduce painful propofol injections. Overall, the quality of the evidence was high. Currently available data from RCTs are sufficient to confirm that both lidocaine admixture and pretreatment were effective in reducing pain on propofol injection.
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